Nurse Maria Dulce (left) assists a mother and her newborn son, who is sleeping under a mosquito net at Malahice Health Centre in Mozambique.

By Thierry Delvigne-Jean

CHIBUTO DISTRICT, Mozambique, 3 December 2008 – Until about two years ago, lack of adequate maternal and neonatal health services in the remote rural town of Malahice meant that many children died needlessly, especially if they were born to mothers living with HIV.

Now, as part of a nationwide scaling-up of Prevention of Mother-to-Child Transmission (PMTCT) programmes, Malahice Health Centre offers a comprehensive treatment package, helping women and children to receive all the services they need during pregnancy and beyond.

“I lost my first child a few days after he was born, and my second child died three months after the birth,” said Mariana*, sitting in the maternity ward at the Malahice Health Centre.

It has only been a day since Carlos – her third child – came into the world. Wrapped in the soft folds of a blanket, Carlos is sleeping intently at his mother’s side, oblivious to the bright sunlight shining through the large windows in the room.

“This is why I agreed to take the HIV test,” said Mariana, smiling at her son with a hopeful look. “Now I’m in the PMTCT programme, and I have been following all the recommendations that the nurses have been giving me to help Carlos from becoming infected. I am hopeful that at least this son will survive.”

Treatment and care for pregnancy and beyond

The introduction, at the end of 2006, of Provider-Initiated Counselling and Testing as part of the antenatal consultation has meant that pregnant women are routinely offered HIV testing and counselling, which has led to an increase in the number of women who know their HIV status and enrol in the PMTCT programme.

Women who are found to be living with HIV receive a course of combination therapy for antiretroviral prophylaxis during their pregnancy and during delivery. Their babies are treated within 24 hours of birth.

But treatment is only part of the package. PMTCT services also include psycho-social support, family planning and information on nutrition and infant feeding options to reduce the risk of transmission during breastfeeding.

Newborns are enrolled in a special programme which involves closer monitoring of their health status during regular vaccination and growth monitoring activities as well as referral to ART sites, if the child’s conditions requires it.

Addressing fear and lack of information

The Ministry of Health’s national policy is to integrate PMTCT services into existing maternal and child health facilities and link them with other health services such as paediatric treatment programmes, malaria control and nutritional services – an approach that has a positive impact on uptake of PMTCT services.

Marie Dulce, a maternal and child health nurse at the Malahice Health Centre, says she has seen a shift in attitudes among women who come to the clinic. “Not long ago, few women would agree to take an HIV test or go to follow-up consultations,” said Ms. Dulce, who concedes that lack of information and fear still keep some women away.

In response, health authorities, with support from UNICEF, began outreach activities involving traditional birth attendants and other community leaders to advise women on the importance of taking the HIV test and seeking proper treatment.

Mother’s groups also offer support and education, and are available in each health centre offering PMTC services. The groups are open to all pregnant women and mothers with children under the age of 18 who are living with HIV.

Nationwide adherence

There is now a great effort to provide comprehensive HIV testing at antenatal care consultations and adherence to the PMTCT programme at the Malahice Health Centre.

“All 124 women who came to antenatal consultations in April this year were tested –39 women are now enrolled in the PMTCT programme,” said Ms. Dulce.

Since UNICEF started to support the Ministry of Health in the nationwide scale-up of PMTCT six years ago, the number of health centres offering PMTCT increased to more than 500 by mid-2008, up from only eight in 2002.

The Ministry of Health aims to expand PMTCT services in all health facilities with antenatal care and maternity wards. By the end of 2007, about half the health units in the country were offering PMTCT services.